The 305 Hospital of PLA (People's Liberation Army), Beijing.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
J Cardiovasc Med (Hagerstown). 2023 Aug 1;24(8):578-584. doi: 10.2459/JCM.0000000000001518. Epub 2023 Jun 26.
Hypoproteinemia is common in patients with acute heart failure, especially in the intensive care unit (ICU). We assessed short-term mortality in patients with acute heart failure for albumin and nonalbumin users.
Our study was a retrospective, observational and single-center study. We included patients with acute heart failure from the Medical Information Mart for Intensive Care-IV and compared short-term mortality and length of hospital stay in patients with and without albumin use. We used propensity score matching (PSM) to adjust for confounders, a multivariate Cox proportional hazard regression model, and performed subgroup analysis.
We enrolled 1706 patients with acute heart failure (318 albumin users and 1388 nonalbumin users). The 30-day overall mortality rate was 15.1% (258/1706). After PSM, the 30-day overall mortality was 22.9% (67/292) in the nonalbumin group and 13.7% (40/292) in the albumin group. In the Cox regression model, after propensity matching, the albumin use group was associated with a 47% reduction in 30-day overall mortality [hazard ratio (HR) = 0.53, 95% confidence interval (CI): 0.36-0.78, P = 0.001]. In subgroup analysis, the association was more significant in males, patients with heart failure with reduced ejection fraction (HFrEF), and nonsepsis patients.
In conclusion, our investigation suggests that the use of albumin was associated with lower 30-day mortality in patients with acute heart failure, especially in males, those aged >75 years, those with HFrEF, those with higher N-terminal pro-brain natriuretic peptide levels, and those without sepsis.
低蛋白血症在急性心力衰竭患者中很常见，尤其是在重症监护病房（ICU）。我们评估了白蛋白和非白蛋白使用者的急性心力衰竭患者的短期死亡率。
我们的研究是一项回顾性、观察性和单中心研究。我们纳入了来自医疗信息集市-重症监护 IV（Medical Information Mart for Intensive Care-IV）的急性心力衰竭患者，并比较了使用白蛋白和不使用白蛋白的患者的短期死亡率和住院时间。我们使用倾向评分匹配（PSM）来调整混杂因素，使用多变量 Cox 比例风险回归模型，并进行亚组分析。
我们纳入了 1706 例急性心力衰竭患者（318 例白蛋白使用者和 1388 例非白蛋白使用者）。30 天总死亡率为 15.1%（258/1706）。经过 PSM 后，非白蛋白组的 30 天总死亡率为 22.9%（67/292），白蛋白组为 13.7%（40/292）。在 Cox 回归模型中，经过倾向匹配后，白蛋白组的 30 天总死亡率降低了 47%[风险比（HR）=0.53，95%置信区间（CI）：0.36-0.78，P=0.001]。在亚组分析中，这种关联在男性、射血分数降低的心力衰竭（HFrEF）患者和非脓毒症患者中更为显著。
总之，我们的研究表明，急性心力衰竭患者使用白蛋白与 30 天死亡率降低相关，尤其是男性、年龄>75 岁、HFrEF、N 端脑利钠肽前体水平较高和无脓毒症的患者。
